Implants for HIV prevention in young women: Provider perceptions and lessons learned from contraceptive implant provision

Preventing new HIV infections, especially amongst young women, is key to ending the HIV epidemic especially in sub-Saharan Africa. Potent antiretroviral (ARV) drugs used as pre-exposure prophylaxis (PrEP) are currently being formulated as long-acting implantable devices, or nanosuspension injectables that release drug at a sustained rate providing protection from acquiring HIV. PrEP as implants (PrEP Implants) offers an innovative and novel approach, expanding the HIV prevention toolbox. Feedback from providers and future users in the early clinical product development stages may identify modifiable characteristics which can improve acceptability and uptake of new technologies. Healthcare workers (HCWs) perspectives and lessons learned during the rollout of contraceptive implants will allow us to understand what factors may impact the roll-out of PrEP implants. We conducted eighteen interviews with HCWs (9 Nurses and 9 Community Healthcare Workers) in rural KwaZulu-Natal, South Africa. HCWs listed the long-acting nature of the contraceptive implant as a key benefit, helping to overcome healthcare system barriers like heavy workloads and understaffing. However, challenges like side effects, migration of the implant, stakeholder buy-in and inconsistent training on insertion and removal hampered the roll-out of the contraceptive implant. For PrEP implants, HCWs preferred long-acting products that were palpable and biodegradable. Our findings highlighted that the characteristics of PrEP implants that are perceived to be beneficial by HCWs may not align with that of potential users, potentially impacting the acceptability and uptake of PrEP implants. Further our data highlight the need for sustained and multi-pronged approaches to training HCWs and introducing new health technologies into communities. Finding a balance between the needs of HCWs that accommodate their heavy workloads, limited resources at points of delivery of care and the needs and preferences of potential users need to be carefully considered in the development of PrEP implants.

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Making prevention public: The co-production of gender and technology in HIV prevention research

Social Studies of Science ◽

10.1177/0306312712457707 ◽

2012 ◽

Vol 42 (6) ◽

pp. 922-944 ◽

Cited By ~ 22

Author(s):

Catherine M. Montgomery

Keyword(s):

Hiv Prevention ◽

New Technologies ◽

Sub Saharan Africa ◽

Therapeutic Success ◽

Vaginal Microbicides ◽

Gender And Technology ◽

Sub Saharan ◽

The Uk ◽

Design And Testing

This paper brings together the study of transnational flows in global health and the gendering of technological artefacts. It does so through a case study of vaginal microbicides for HIV prevention, which have commonly been advocated for as a tool for women’s empowerment in parts of the world where HIV is most prevalent, namely sub-Saharan Africa. Drawing on fieldwork in the UK and Zambia, I argue that there is nothing inherently gendered about this ‘woman-controlled’ technology. Combining the notions of scripting and ‘making things public’, I demonstrate the political nature of transnational technology design and testing in the field of sexual health. Rather than framing this in terms of ethical debates, as is frequently the case in studies about the ‘global South’, I ground the analysis in the scripting and de-scripting of technologies and users. By focusing on how things are made public in HIV prevention, I draw attention to the normative, transformative and political potentials of new technologies, such as microbicides, and discuss the implications for their therapeutic success.

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Experiences and Perspectives on Spodoptera frugiperda (Lepidoptera: Noctuidae) Management in Sub-Saharan Africa

Journal of Integrated Pest Management ◽

10.1093/jipm/pmab002 ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Elizabeth Njuguna ◽

Phophi Nethononda ◽

Karim Maredia ◽

Ruth Mbabazi ◽

Paul Kachapulula ◽

...

Keyword(s):

Spodoptera Frugiperda ◽

New Technologies ◽

Integrated Management ◽

Fall Armyworm ◽

Lessons Learned ◽

Sub Saharan Africa ◽

Invasive Pest ◽

Published Evidence ◽

Sub Saharan ◽

Lepidoptera Noctuidae

Abstract It has been over five years since the first report of an outbreak of the fall armyworm, Spodoptera frugiperda (J.E. Smith) (Lepidoptera: Noctuidae) in Africa. The highly invasive pest, native to the Americas, has since spread across the African continent attacking many crops and causing significant yield loss to Africa’s staple crop, maize. From the onset of the outbreak, there have been massive and varied responses from farmers, governments and nongovernmental organizations. This mini-review provides various perspectives on S. frugiperda control in sub-Saharan Africa, building on previously published evidence, and experiences of the authors. It also highlights new technologies and lessons learned so far from the S. frugiperda outbreaks in sub-Saharan Africa, based on which suggestions on possible integrated management approaches are proffered.

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Social Inclusion and Immunisation

10.19088/k4d.2021.025 ◽

2021 ◽

Author(s):

Kerina Tull

Keyword(s):

Social Inclusion ◽

Democratic Republic Of Congo ◽

Risk Groups ◽

Lessons Learned ◽

Sub Saharan Africa ◽

Rapid Review ◽

Cultural Challenges ◽

Sub Saharan ◽

The Government ◽

Roll Out

The current COVID-19 epidemic is both a health and societal issue; therefore, groups historically excluded and marginalised in terms of healthcare will suffer if COVID-19 vaccines, tests, and treatments are to be delivered equitably. This rapid review is exploring the social and cultural challenges related to the roll-out, distribution, and access of COVID-19 vaccines, tests, and treatments. It highlights how these challenges impact certain marginalised groups. Case studies are taken from sub-Saharan Africa (the Democratic Republic of Congo, South Africa), with some focus on South East Asia (Indonesia, India) as they have different at-risk groups. Lessons on this issue can be learned from previous pandemics and vaccine roll-out in low- and mid-income countries (LMICs). Key points to highlight include successful COVID-19 vaccine roll-out will only be achieved by ensuring effective community engagement, building local vaccine acceptability and confidence, and overcoming cultural, socio-economic, and political barriers that lead to mistrust and hinder uptake of vaccines. However, the literature notes that a lot of lessons learned about roll-out involve communication - including that the government should under-promise what it can do and then over-deliver. Any campaign must aim to create trust, and involve local communities in planning processes.

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Innovative Healthcare Technologies in Otorhinolarnygological Practice in Sub-Saharan Africa: Strategies for Accelerated Uptake

Western Journal of Medical and Biomedical Sciences ◽

10.46912/wjmbs.8 ◽

2020 ◽

Vol 1 (1) ◽

pp. 58-63

Author(s):

OE Braimah ◽

AL Okhakhu

Keyword(s):

Literature Review ◽

New Technologies ◽

Daily Practice ◽

Sub Saharan Africa ◽

Patient Comfort ◽

Technological Innovations ◽

Health Technologies ◽

The World ◽

Healthcare Technologies ◽

Sub Saharan

Healthcare innovations are geared towards greater patient comfort, improved diagnosis and better treatment outcomes. Otorhinolaryngology (ORL) has witnessed many technological innovations become a core aspect of daily practice. Sub-Saharan Africa is currently lagging behind the rest of the world in both development and uptake of innovative health technologies. This paper aims to examine these innovations in otorhinolaryngology as well as the challenges and routes to their timely deployment in Sub-Saharan Africa (SSA). A literature review was conducted on papers retrieved from Google scholar and Pubmed. Several factors have hampered practitioners in SSA from fully leveraging new technologies. By applying political, legal, economic, educational and scientific strategies these practitioners may adopt safe, effective, home-grown adaptations of emerging technologies for accelerated uptake.

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P4.116 Long-acting reversible contraceptive use and receipt of sexual health services among young women: implications for sti/hiv prevention

10.1136/sextrans-2017-053264.611 ◽

2017 ◽

Author(s):

Riley Steiner ◽

Karen Pazol ◽

Andrea L Swartzendruber ◽

Michael R Kramer ◽

Laurie Gaydos ◽

...

Keyword(s):

Hiv Prevention ◽

Health Services ◽

Sexual Health ◽

Young Women ◽

Contraceptive Use ◽

Long Acting ◽

Long Acting Reversible Contraceptive

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Is it time to RE-AIM? A systematic review of economic empowerment as HIV prevention intervention for adolescent girls and young women in sub-Saharan Africa using the RE-AIM framework

Implementation Science Communications ◽

10.1186/s43058-020-00042-4 ◽

2020 ◽

Vol 1 (1) ◽

Cited By ~ 1

Author(s):

Juliet Iwelunmor ◽

Ucheoma Nwaozuru ◽

Chisom Obiezu-Umeh ◽

Florida Uzoaru ◽

John Ehiri ◽

...

Keyword(s):

Systematic Review ◽

Hiv Prevention ◽

Adolescent Girls ◽

Young Women ◽

Sub Saharan Africa ◽

Economic Empowerment ◽

Prevention Intervention ◽

Hiv Prevention Intervention ◽

Sub Saharan

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A community-based mobile clinic model delivering PrEP for HIV prevention to adolescent girls and young women in Cape Town, South Africa

BMC Health Services Research ◽

10.1186/s12913-021-06920-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Elzette Rousseau ◽

Linda-Gail Bekker ◽

Robin F. Julies ◽

Connie Celum ◽

Jennifer Morton ◽

...

Keyword(s):

South Africa ◽

Hiv Prevention ◽

Adolescent Girls ◽

Young Women ◽

Scale Up ◽

Cape Town ◽

Sub Saharan Africa ◽

Health Clinic ◽

Community Based ◽

Depth Interviews

Abstract Background Daily doses of pre-exposure prophylaxis (PrEP) can reduce the risk of acquiring HIV by more than 95 %. In sub-Saharan Africa, adolescent girls and young women (AGYW) are at disproportionately high risk of acquiring HIV, accounting for 25 % of new infections. There are limited data available on implementation approaches to effectively reach and deliver PrEP to AGYW in high HIV burden communities. Methods We explored the feasibility and acceptability of providing PrEP to AGYW (aged 16–25 years) via a community-based mobile health clinic (CMHC) known as the Tutu Teen Truck (TTT) in Cape Town, South Africa. The TTT integrated PrEP delivery into its provision of comprehensive sexual and reproductive health services (SRHS). We analyzed data from community meetings and in-depth interviews with 30 AGYW PrEP users to understand the benefits and challenges of PrEP delivery in this context. Results A total of 585 young women started PrEP at the TTT between July 2017 – October 2019. During in-depth interviews a subset of 30 AGYW described the CMHC intervention for PrEP delivery as acceptable and accessible. The TTT provided services at times and in neighborhood locations where AGYW organically congregate, thus facilitating service access and generating peer demand for PrEP uptake. The community-based nature of the CMHC, in addition to its adolescent friendly health providers, fostered a trusting provider-community-client relationship and strengthened AGYW HIV prevention self-efficacy. The integration of PrEP and SRHS service delivery was highly valued by AGYW. While the TTT’s integration in the community facilitated acceptability of the PrEP delivery model, challenges faced by the broader community (community riots, violence and severe weather conditions) also at times interrupted PrEP delivery. Conclusions PrEP delivery from a CMHC is feasible and acceptable to young women in South Africa. However, to effectively scale-up PrEP it will be necessary to develop diverse PrEP delivery locations and modalities to meet AGYW HIV prevention needs.

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Knowledge, attitudes, and perceptions of long-acting reversible contraceptive (LARC) methods among healthcare workers in sub-Saharan Africa: a systematic review and meta-analysis

10.1101/2020.10.27.20220434 ◽

2020 ◽

Author(s):

Laura Rouncivell ◽

Simbarashe Takuva ◽

Neo Ledibane ◽

Alfred Musekiwa ◽

Trudy D Leong

Keyword(s):

Systematic Review ◽

Publication Bias ◽

Healthcare Workers ◽

Meta Analysis ◽

Sub Saharan Africa ◽

Contraceptive Device ◽

Attitudes And Perceptions ◽

Sub Saharan ◽

Long Acting ◽

Long Acting Reversible Contraceptive

ABSTRACTObjectiveTo assess the knowledge, attitudes, and perceptions (KAP) of long-acting reversible contraceptive (LARC) methods among healthcare workers (HCW’s) in sub-Saharan Africa (SSA).MethodsA systematic review and meta-analysis were conducted following the PRISMA methodology. Two authors independently searched three electronic databases for studies published between 2000 and January 2020 reporting on the KAP of LARC methods among HCW’s in SSA. Titles and abstracts were screened against eligibility criteria, data were extracted and the included studies were assessed for risk of bias. A meta-analysis of proportions for 11 pre-determined questions relating to LARC KAP was performed. Heterogeneity was explored using the I2-statistic and publication bias investigated using funnel plots and Egger’s tests.ResultsTwenty-two studies comprising of 11 272 HCW’s from 11 SSA countries were included. Forty-one percent (95% CI: 20%, 61%) of HCW’s had received intrauterine contraceptive device (IUCD) insertion training while 63% (95% CI: 44%, 81%) expressed a desire for training. Only 27% (95% CI: 18%, 36%) deemed IUCD appropriate for HIV-infected women. Restrictions for IUCD and injectables based on a minimum age were imposed by 56% (95% CI: 33%, 78%) and 60% (95% CI: 36%, 84%), respectively. Minimum parity restrictions were observed among 29% (95% CI: 9%, 50%) of HCW’s for IUCDs and 36% (95% CI: 16%, 56%) for injectable contraceptives. Heterogeneity was high and publication bias was present in two of the 11 questions.ConclusionThe systematic review and meta-analysis indicate that unnecessary provider-imposed restrictions may hinder the uptake of LARC methods by women in SSA.

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HIV Infection and AIDS in Sub-Saharan Africa: Current Status, Challenges and Opportunities

The Open AIDS Journal ◽

10.2174/1874613601610010034 ◽

2016 ◽

Vol 10 (1) ◽

pp. 34-48 ◽

Cited By ~ 233

Author(s):

Ayesha B.M. Kharsany ◽

Quarraisha A. Karim

Keyword(s):

Hiv Prevention ◽

Hiv Infection ◽

Young Women ◽

Sub Saharan Africa ◽

Current Status ◽

Global Burden ◽

Medical Male Circumcision ◽

Global Trends ◽

Sub Saharan ◽

Disproportionate Burden

Global trends in HIV infection demonstrate an overall increase in HIV prevalence and substantial declines in AIDS related deaths largely attributable to the survival benefits of antiretroviral treatment. Sub-Saharan Africa carries a disproportionate burden of HIV, accounting for more than 70% of the global burden of infection. Success in HIV prevention in sub-Saharan Africa has the potential to impact on the global burden of HIV. Notwithstanding substantial progress in scaling up antiretroviral therapy (ART), sub-Saharan Africa accounted for 74% of the 1.5 million AIDS related deaths in 2013. Of the estimated 6000 new infections that occur globally each day, two out of three are in sub-Saharan Africa with young women continuing to bear a disproportionate burden. Adolescent girls and young women aged 15-24 years have up to eight fold higher rates of HIV infection compared to their male peers. There remains a gap in women initiated HIV prevention technologies especially for women who are unable to negotiate the current HIV prevention options of abstinence, behavior change, condoms and medical male circumcision or early treatment initiation in their relationships. The possibility of an AIDS free generation cannot be realized unless we are able to prevent HIV infection in young women. This review will focus on the epidemiology of HIV infection in sub-Saharan Africa, key drivers of the continued high incidence, mortality rates and priorities for altering current epidemic trajectory in the region. Strategies for optimizing the use of existing and increasingly limited resources are included.

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